The medical student was confused. “Well, that’s not good.”
He was seeing, in black and white, the benefits and harms of statin medicines. After years of systematic inculcation about the power of cholesterol reduction, this was the first time he had seen the numbers.
“I don’t get it. I thought cholesterol was the big player in heart attacks.”
Not really. Three-quarters of people having a first heart attack, for instance, have normal cholesterol levels.
Indeed. In fact, 50 years ago during the Framingham Heart Study, researchers first suggested that cholesterol may be a weak risk factor for heart disease. This led to a parade of drugs (fibrates, niacin, ezetemibe, etc.) that, despite lowering cholesterol, didn’t help people live longer or avoid heart attacks.
“I’ve never heard that.”
It gets worse: When the completed, 30-year data from the study was analyzed, in most age groups high cholesterol wasn’t associated with more deaths. In fact, for older people, deaths were more common with low cholesterol.
“Now wait. Statins are supposed to be a ‘miracle drug.’ Heart disease is declining, right?”
Actually, heart disease deaths started dropping 40 years ago and the rate of that decline is completely unchanged since statins came into widespread use. On a public health scale, statins are a failure.
“This is insane.”